Moving differently in pain: A new theory to explain the adaptation to pain

Hodges, Paul W.; Tucker, Kylie

doi:10.1016/j.pain.2010.10.020

Cited by 800 publications

(798 citation statements)

References 96 publications

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“…The results of the present study support the model recently proposed by Hodges and Tucker (37). Rather than uniform effects (inhibition or excitation) of pain on the motoneuron pool, it is proposed that pain causes a redistribution of activity within and between muscles (37).…”

Section: Discussionsupporting

confidence: 91%

Experimental knee joint pain during strength training and muscle strength gain in healthy subjects: A randomized controlled trial

Sørensen¹,

Langberg²,

Hodges³

et al. 2011

Arthritis Care & Research

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Objective. Knee joint pain and reduced quadriceps strength are cardinal symptoms in many knee pathologies. In people with painful knee pathologies, quadriceps exercise reduces pain, improves physical function, and increases muscle strength. A general assumption is that pain compromises muscle function and thus may prevent effective rehabilitation. This study evaluated the effects of experimental knee joint pain during quadriceps strength training on muscle strength gain in healthy individuals. Methods. Twenty-seven healthy untrained volunteers participated in a randomized controlled trial of quadriceps strengthening (3 times per week for 8 weeks). Participants were randomized to perform resistance training either during pain induced by injections of painful hypertonic saline (pain group, n ‫؍‬ 13) or during a nonpainful control condition with injection of isotonic saline (control group, n ‫؍‬ 14) into the infrapatellar fat pad. The primary outcome measure was change in maximal isokinetic muscle strength in knee extension/flexion (60, 120, and 180 degrees/second). Results. The group who exercised with pain had a significantly larger improvement in isokinetic muscle strength at all angular velocities of knee extension compared to the control group. In knee flexion there were improvements in isokinetic muscle strength in both groups with no between-group differences. Conclusion. Experimental knee joint pain improved the training-induced gain in muscle strength following 8 weeks of quadriceps training. It remains to be studied whether knee joint pain has a positive effect on strength gain in patients with knee pathology.

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Section: Discussionsupporting

confidence: 91%

Experimental knee joint pain during strength training and muscle strength gain in healthy subjects: A randomized controlled trial

Sørensen¹,

Langberg²,

Hodges³

et al. 2011

Arthritis Care & Research

View full text Add to dashboard Cite

show abstract

“…Furthermore, computer model simulations have confirmed that force fluctuations are very sensitive to changes in motor unit recruitment strategy and spatial reorganization of active motor units (particularly at low force levels) (Fuglevand et al 1993;Taylor et al 2003), which are commonly reported by experimental pain studies using intramuscular and multichannel surface EMG electrodes (Madeleine et al 2006;Falla et al 2007;Tucker and Hodges 2010). Although it has been suggested that pain adaptations in muscle function typically aim at the protection of the painful site against further pain or injury (Hodges and Tucker 2011), the present data show that they may also result in impairments in the steadiness of force.…”

Section: Pain-adaptation Strategymentioning

confidence: 69%

Experimental muscle pain increases normalized variability of multidirectional forces during isometric contractions

Salomoni

Graven‐Nielsen

2012

Eur J Appl Physiol

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Pain elicits complex adaptations of motor strategy, leading to impairments in the generation and control of steady forces, which depend on muscle architecture. The present study used a cross-over design to assess the effects of muscle pain on the stability of multidirectional (task-related and tangential) forces during sustained dorsiflexions, elbow flexions, knee extensions, and plantarflexions. Fifteen healthy subjects performed series of isometric contractions (13 s duration, 2.5%, 20%, 50%, 70% of maximal voluntary force) before, during, and after experimental muscle pain. Three-dimensional force magnitude, angle and variability were measured while the task-related force was provided as feedback to the subjects. Surface electromyography was recorded from agonist and antagonist muscles. Pain was induced in agonist muscles by intramuscular injections of hypertonic (6%) saline with isotonic (0.9%) saline injections as control. The pain intensity was assessed on an electronic visual analogue scale (VAS). Experimental muscle pain elicited larger ranges of force angle during knee extensions and plantarflexions (P<0.03) and higher normalized fluctuations of task-related (P<0.02) and tangential forces (P<0.03) compared with control assessments across force levels, while the mean force magnitudes, mean force angle and the level of muscle activity were non-significantly affected by pain. Increased multidirectional force fluctuations probably resulted from multiple mechanisms that, acting together, balanced the mean surface EMG. Although pain adaptations are believed to aim at the protection of the painful site, the current results show that they result in impairments in steadiness of force.

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“…dans [10]) puis a été étendu à l'appareil locomoteur et au système spinal [11]. Ces deux théories ont fait l'objet d'une analyse critique ; même si le modèle de Lund est celui qui est le mieux accepté par la communauté scientifique, il n'explique pas certains faits cliniques ou expérimentaux [12,13].…”

Section: Dysfonctionnements Musculaires Douloureux Lors D'activités Punclassified

“…Il y a sans doute des régulations motrices encéphaliques liées à la douleur persistante/chronique et/ou aux facteurs psychiques, notamment la kinésiophobie (voir ci-après). Mais ces régulations motrices descendantes (top-down) peu connues dans les TMS, font actuellement l'objet de recherche [13].…”

Section: Dysfonctionnements Musculaires Douloureux Lors D'activités Punclassified

Dysfonctionnements musculaires douloureux de l’appareil manducateur et dysfonctionnements cervicaux et linguaux connexes (3^e partie)

Fougeront

Garnier

Fleiter

2014

Med Buccale Chir Buccale

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Résumé -D'après le « modèle de l'adaptation à la douleur », dans les algies et dysfonctionnements de l'appareil manducateur (ADAM) il y a une activité paradoxale des muscles masticateurs : une hypoactivité agoniste à l'élévation et une faible hyperactivité antagoniste (co-activation agoniste/antagoniste) à l'abaissement mandibulaire ; ces régulations motrices induites par la douleur impliquent le système moteur trigéminal (V) segmentaire et/ou le CPG de la mastication. Malgré la puissance de ce modèle, il n'explique pas toutes les adaptations motrices dans les cervicalgies. Cela peut être dû : à la complexité de la colonne cervicale (avec ses nombreux muscles agonistes, antagonistes et synergistes) ; et à la spécificité du système neuromusculaire cervical impliqué dans la posture céphalique/corporelle, la perméabilité des voies aérifères supérieures, l'activité du bras/ ceinture scapulaire et du cou, et enfin l'activité du cou et de la mâchoire. À part la douleur, le stress psychologique peut aussi entraîner des dysfonctionnements dans les troubles musculo-squelettiques (par exemple kinésiophobie, mise au repos difficile). Enfin, il est possible que les dysfonctionnements linguaux soient en interrelations avec les ADAM : la diminution de l'activité agoniste des muscles élévateurs favoriserait la déglutition immature où l'activité des muscles peauciers (VII) prédomine sur celle des muscles masticateurs (V).Abstract -Manducatory apparatus myofascial pain and dysfunction and connected cervical spine and tongue dysfunction (3 rd part). According to the "pain adaptation model", temporomandibular disorder (TMD) pain induces a paradoxical activity of masticatory muscles: an agonistic hypoactivity during jaw closing and a weak antagonistic activity during jaw opening (agonist/antagonist co-activation); the pain-induced motor regulation implies the segmental trigeminal (V) motor system and/or CPG. This model has been extended to other types of musculoskeletal disorders (MSD). However, despite its power, this model does not fit with all types of neck muscle activities in neck pain. This discrepancy may be due: to the complexity of the cervical spine (with its numerous agonist, antagonist and synergist muscles), and to the specificities of the cervical neuromuscular system in interrelationships with the control of body and head posture, the patency of the upper airway depending on head/ cervical posture, the neck and arm/shoulder muscles' activity, and finally, the neck and masticatory muscles' activity. Besides pain, psychological stress may induce motor dysfunction in MSD (e.g. kinesiophobia, difficulty switching off). Finally, it is hypothesised that tongue dysfunction could be connected to TMD (due to intersegmental coordination between V, VII and XII motor nuclei): the weakness of the agonistic activity of masticatory muscles would favour immature deglutition, where facial muscle (VII) activity predominates over masticatory muscle (V) activity.

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Moving differently in pain: A new theory to explain the adaptation to pain

Cited by 800 publications

References 96 publications

Experimental knee joint pain during strength training and muscle strength gain in healthy subjects: A randomized controlled trial

Experimental knee joint pain during strength training and muscle strength gain in healthy subjects: A randomized controlled trial

Experimental muscle pain increases normalized variability of multidirectional forces during isometric contractions

Dysfonctionnements musculaires douloureux de l’appareil manducateur et dysfonctionnements cervicaux et linguaux connexes (3^e partie)

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Moving differently in pain: A new theory to explain the adaptation to pain

Cited by 800 publications

References 96 publications

Experimental knee joint pain during strength training and muscle strength gain in healthy subjects: A randomized controlled trial

Experimental knee joint pain during strength training and muscle strength gain in healthy subjects: A randomized controlled trial

Experimental muscle pain increases normalized variability of multidirectional forces during isometric contractions

Dysfonctionnements musculaires douloureux de l’appareil manducateur et dysfonctionnements cervicaux et linguaux connexes (3e partie)

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Dysfonctionnements musculaires douloureux de l’appareil manducateur et dysfonctionnements cervicaux et linguaux connexes (3^e partie)